MP324 - EXACERBATIONS

Question 1

well-controlled asthma symptoms

Answer 1

• no daytime symptoms
• no night wakening due to asthma
• no need for rescue medication
• no asthma attacks
• no limitations on activity including exercise
• normal lung function (PEFR>80%)

Question 2

signs and symptoms of moderate asthma

Answer 2

PEFR 50-75%
patient should be able to manage therapy themselves or in primary care

Question 3

signs and symptoms of severe asthma

Answer 3

(any 1 one the following)
PEFR 33-50%
unable to talk in sentences
RR>25
pulse>110

Question 4

treatment of severe asthma

Answer 4

referral to hospital
oxygen 40-60% via a venturi mask
oral corticosteroid (prednisolone 40-50mg)
nebulised SABA
nebulised SAMA if needed

Question 5

clinical signs of life-threatening asthma

Answer 5

altered conscious level
exhaustion
arrhythmia
hypotension
cyanosis
silent chest
poor respiratory effort

Question 6

measurements of life-threatening asthma

Answer 6

PEFR <33%
SpO2 <92%
PaO2 <8kPa
‘normal’ PaCO2 (4.6-6.0)

Question 7

treatment of life-threatening asthma

Answer 7

immediate hospital admission
nebulised beta agonists and ipratropium
oral corticosteroids (prednisolone 40-50mg OD)
oxygen if SpO2<92%, PEFR<60%; target 94-98%
IV aminophylline, salbutamol or terbutaline
IV magnesium
IV fluids/electrolytes especially K

Question 8

patient monitoring

Answer 8

RR
pulse
oxygen saturation
PEFR (before and after SABA)
blood gases (PaO2 and PaCO2)

Question 9

likely pathogens in COPD

Answer 9

strep pneumoniae
haemophilus influenzae
moraxella catarrhalis

Question 10

treatment for pathogens in COPD

Answer 10

• amoxicillin 500mg every 8 hours
• doxycycline 200mg as a single dose then 100mg OD
• clarithromycin 500mg every 12 hours
• consider mechanical ventilation (extreme cases)